Reimbursement issues in advanced practice nursing: an overview

In this era of rapid change and restructuring of the health care delivery system, APNs are faced with many new opportunities and challenges. This implies that APNs should know the federal and state laws, rules, and regulations that clearly define their scope of practice and prescriptive authority. They should familiarize themselves with Medicare and Medicaid payment policies, and the state laws related to the private insurance practices. By learning the basic language of third-party payers, APNs will find themselves in a better position of understanding the process that ensures reimbursement for the services rendered. Thus, APNs should keep up with the new demand for their expertise by having close ties with new knowledge and new technologies. In addition, APNs should have the skills, credentials, and the knowledge of computer technology for communication, distance learning, diagnosis, and treatment. The ultimate goal is to provide high-quality and cost-effective care.